Feb 15

Why Can’t My Lactation Consultant Fix All My Breastfeeding Problems in 1 Visit?

lactation consultantAn important concept to know is that healing and hope come in the follow up  I have been working as an IBCLC for 12 years and one thing that is certain, the care plan established in the initial visit can change as little as 24 hours. If the moms results are short lived she may feel that the original plan provided by her lactation consultant isn’t working, then comes the discouragement and frustration. Frustration that she just spent money on something without long lasting results and discouragement that the care plan isn’t working and therefore, breastfeeding is back to being a hassle.

There appears to a discrepancy in the expectations of a lactation consultation. With out follow up, mom and baby often times aren’t getting the results and support they are needing to succeed. By the time someone needs to see an IBCLC, it is almost never a one time direct and simple solution. There are multiple issues going on. Often times mom is on a roller coaster and it takes time to figure out which issue is causing the roller coaster to keep going. Keep in mind that the IBCLC is the only health care provider that has to assess two people; mom and her infant. She may need more time to observe mom and baby, assess and take more information from the mom to figure out the best plan of action.

When someone decides they need to see a counselor or therapist, it is understood that the changes are in the follow up. No one expects the therapist to solve a person’s problems all in a single visit. That is why there is always follow up. Those who have had contract workers in their home, if the problems still exist, you don’t ignore the problem or call a neighbor to help in hopes that the water damage for example goes away without intervention, we call the professional back for follow up. When we choose to see a chiropractor for whatever health reason, the healing can’t come unless there is a consistent commitment in the follow up.

http://www.dreamstime.com/stock-image-newborn-baby-sucking-mother-s-milk-image14510111Majority of breastfeeding issues and concerns are resolved in multiple visits. Mom often times feel embarrassed that she needs to come back to see her Lactation Consultant as breastfeeding should come naturally, right? This statement is a myth because breastfeeding isn’t always dependent on a mom’s lack of will power, control or education.

As that initial care plan can change, so will each visit. We have to take into account the training the baby needs. We have to give the initial care plan time to see if it is the right fit for mom’s real life circumstances and taking into consideration the infant’s time table. Has the mom done everything that the IBCLC has told her to do first before throwing in the towel? Sometimes breastfeeding information is absolute. If mom does not do X, Y and Z she isn’t going to get the results she wants no matter how many people she asks on Facebook or in her neighborhood or family. If she follows everything her IBCLC tells her to do and the results aren’t there tells the IBCLC that the plan does indeed need to be changed, reassessed and reevaluated. This is why a mom needs to see the IBCLC several times and why the 1 hour visit couldn’t possibly be a quick fix solution. A nursing mom deserves easy breastfeeding. She deserves peace of mind. She deserves to have pain free breastfeeding. She deserves to be validated and respected for what she can do. She deserves to have the on-going support to make sure her experiences in breastfeeding and her value on successful breastfeeding go as smoothly as possible. On-going support is vital in making sure mom and baby get all of these things.

Feb 15

Your Nipples Want You to Call Me!

As an International Board Certified Lactation Consultant, IBCLC, and a Certified Life Coach, I am fascinated with human behavior.  I find it very interesting why women seek out help from an IBCLC while others who struggle with breastfeeding do not. Here are some, not all of the reasons why women choose not to work with an IBCLC.

  • I should be able to figure this out on my own.
  • We can’t afford it… or in other words, I can’t get my husband to agree that my nipple pain or breastfeeding struggles are out of my control.
  • I have already talked to my neighbor who is a Lactation Consultant and she couldn’t help me so why pay for additional help?
  • I sought out breastfeeding advise from my pediatrician/midwife/OB.
  • I don’t think anyone can help me. All the LC’s can’t figure out what is going on.
  • I don’t know who to call because I have one financial shot at making this work.
  • I am so overwhelmed, I don’t want to pay for someone to tell me MORE things to do.
  • I already paid to see someone, I can’t afford another opinion.

In order to receive the help, support, resources, education, assessment and an action plan for hope and healing in breastfeeding, a mom needs to have the desire and means to pay to see a professional. If your toilet is not flushing properly would you ask a neighbor who fixed his toilet recently or seek out a Licensed Plumber? If your husband goes into cardiac arrest, are you going to go to the internet or call 911?

Another thing a mom needs to know about working towards hope and healing her breastfeeding relationship, she isn’t at fault for her struggles. For some reason, the mom may internalize her breastfeeding problems. It is very rarely a mom issue, therefore, waiting for her to figure it out on her own or on-line, usually doesn’t work. Seeing someone in-person is much more effective.

The most important concept to know in hope and healing the breastfeeding relationship is in follow up with a professional in Lactation Management and that is an IBCLC. The IBCLC should be assessing not only latch and positioning but body structure and function in relation to the baby’s body, the function of the tongue and lip in relation to breastfeeding and assessment of moms over all emotional and physical well being as it all relates to her breastfeeding success. An IBCLC looks at EVERYTHING from all angles to make sure a mom has all the options available to her for the achievement of her breastfeeding goals. Aren’t your nipples worth the call?

Oct 18

Lactation Results Come With a Price

Lactation Results Come With a Price:
You get what you pay for when it comes to the pump you purchase, the breastfeeding pillow you want and even the lactation services/support you choose. Is there additional value in spending money on breastfeeding supplies and adequate support? Are you more willing to listen to the advice given if it is free and is that free advice ENOUGH to provide you with healthier results?

I learned today an important lesson in this concept. The story starts out with my son calling me home from a lunch date. He reported that our cat was foaming from the mouth and having diarrhea. Not a wait and see approach or check the internet first for FREE advice. I started calling our regular vet and the back up vet we take our animals too. Neither one was available until the following week. I knew I had no choice but see someone else who was going to cost an arm and a leg.

The veterinarians I have chosen are extremely inexpensive. It has been nice and comforting to get my animals seen and taken care of for an affordable price. Yet, I noticed with this new veterinarian that he was assessing very thoroughly. More than I am used too. This veterinarian confirmed our suspensions of kidney failure. The other veterinarians brushed off my concerns. This new doctor discussed nutrition and developed a care plan to keep my cat living healthier for many years to come. Did it cost a pretty penny? It did. But I learned three important lessons.

Number one, “cheap & inexpensive” may not always mean thorough. Number two, because of being thorough, my cat will be able to live a better quality of life. Number three, what we don’t know from lack of being thorough may cause further issues in the future.

My a-ha moment helped me realize that when moms seeking out breastfeeding assistance need to ask themselves whether they want cheap and inexpensive and just receive a cheerleader or pay extra and receive thorough and healthier results? My consultations provide a thorough assessment on mom’s breasts, milk supply, milk transfer, weight patterns, infant’s oral anatomy and potential issues. I am most proud of my ability to help a mom feel comfortable, empowered, hopeful and have more confidence. The answers a mom needs to succeed are always there. Adding in thoroughness, hope and a prayer is my approach for the best outcome.

Oct 05

Do You Want To Become a Lactation Consultant?

Do you want to become a lactation consultant? I get asked quite frequently from mothers who I have helped overcome breastfeeding challenges to random people who find my website , “How do I do what you do?”  I first give them the descriptions and the differences of each lactation specialist out there as we are not all equal. Lactation Specialist range anywhere in education from self-proclaimed to several years of study and clinical experience. People are very surprised that to be a lactation professional (IBCLC) is more than just teaching other mothers proper latch techniques and the health benefits of breastfeeding.

I have already addressed the differences of each credential in a previous blog post so I will continue to explain how to achieve the golden standard in lactation practice that is the title of IBCLC; International Board Certified Lactation Consultant. This is not the easiest to achieve yet we all had to start somewhere and that is becoming a Certified Lactation Educator, Wic Peer Counselor, Certified Breastfeeding Counselor or a Le Leche League Leader. These are the typical starting grounds and gets you in the door and the means to achieving your complete goal.

Your level of experience and education will determine which route to take toward getting additional college education, specific lactation consultant programs and/or the amount of clinical hours needed. There are three routes explained in more detail on www.ibcle.org. The college training for a non-medical licensed individual will need 12 credit hours in lactation specific college courses in  nutrition, physiology, anatomy and physiology, etc. Your back ground will also determine whether you obtain 500 to 1,000 supervised hours within a job specific role or with a mentor IBCLC.

Getting your clinical hours happens to be the most challenging step. Depending on where you live and your current job location, this can be a perfect fit or a nightmare. When I was going to school to be able to sit for the International Board Exam, I was already employed by several hospitals. I had access to a main mentor and an additional 10 more. I was very fortunate and was in the right place at the right time. Personally, going the mentor route will give you the most preparation and knowledge as you can learn how others do it and do it well. Most people interested in becoming an IBCLC do not have this option. Other ways to get in those important clinical hours is to become a Le Leche League leader, a WIC Peer Counselor and other various breastfeeding clinic locations that are willing to have an intern. I personally believe that if you really want to have a rewarding career helping new mothers with breastfeeding challenges, do not let anything get in the way of your success. Something will open up somewhere, somehow in order for you to achieve the necessary steps if you put the work into it to become the expert in breastfeeding management.

Mar 18

When Lip and Tongue Ties Interfere with Weight Gain

I have to admit that my job is pretty cool. It also has some frustrating moments as well. It is not uncommon for me to see a baby struggling with weight. Some of these babies aren’t even up from their birth weights at 5-6 weeks out. These babies are being seen by medical providers and for whatever reason, the baby is still not gaining weight.

When these babies come into my office, I immediately do a suck assessment. During the suck assessment, I assess for limited range of motion of the lip and tongue. The lip and tongue are crucial in creating a seal at the breast and creating suction. If the tongue and often times the lip are restricted, baby may not be able to transfer milk from the breast and gain adequate weight.

Infants need to gain an average of 5-7 ounces per week for the first 4 months. It is even up for debate in my lactation consultant group that the necessary standards for weight growth is a minimal of 8 ounces per week for the first 4 months.  So when an infant is not gaining anywhere close, the baby is not eating enough. There is no such thing as “small babies.”

When tongue and/or lip restrictions interfere with normal weight growth for an infant and no one mentions the option of revisions, the consequences can be deadly. Mom’s milk supply is compromised. Mom’s confidence is compromised. The infant’s health and well being are compromised.

“Feeding the Baby Enough is Always the #1 Rule in Breastfeeding.”
Helping the baby feed effectively is also the next step. A simple assessment by the IBCLC and a simple procedure called a frenectomy by the pediatrician or a specialist can save a baby’s life. It is a simple solution to an often time over looked and undermine issue.

Feb 15

IBCLC Verses Other Lactation Specialists: Choose Wisely Who To Work With

As a new mom having breastfeeding difficulties, all she is wants is results. If she is having sore nipples, she wants them healed. If her baby is not gaining weight, she wants to give her baby enough to eat, preferably breast milk. In a culture where we can call ourselves anything we want, be aware of some discrepancies in lactation titles as they are all not created equal.

Many people in the birth community call themselves a lactation specialist and even a Certified Lactation Consultants without any formal training. However true that statement is, even those with some certification, the lactation specialist are not all created equal.

Certified programs train students to be Lactation Educators, Lactation Peer Counselors, Breastfeeding Counselors and Lactation Consultants. These programs have a specialized training that will provide class instruction anywhere from 8-45 hours. Some of it is done on-line and others in a conference setting. Most of the courses do not even require the student to  be supervised or have hundreds of hours with a mentor IBCLC.

To become an International Board Certified Lactation Consultant AKA IBCLC, is not quite like the other credentials. An IBCLC has to take at least 90 hours of lactation specific instruction. That is usually done in person in a class atmosphere. They are also required to have a 500-1000 plus hours of being directly supervised or following another mentor IBCLC.  If the IBCLC is not already a licensed healthcare provider, they have to have additional college courses.  After fulfilling all required requirements, the student then qualifies to take the lactation boards. This is a vigorous 4 hour board exam.

As an IBCLC, we have to keep up 75 Lactation specific CEU’s every 5 years. This is more than an RN needs. We also have to retake that vigorous exam every 10 years. If we do not pass, we can not hold the title as an IBCLC or work in the capacity of an IBCLC. Some will lose their ability to work with moms and infants until they pass that exam.

There is a place for all those credentials and lactation specialists, however, an IBCLC is the golden standard in lactation management. None of the other credentials have the ability or skill to give mom and baby a complete and full assessment in regards to the emotional and physical aspect of the nursing mother dyad. It is like telling a trained doula that she can deliver a baby. In some cases a doula will be able to successfully deliver a baby even though that is out of her scope of practice. But she is not trained and skilled in understanding the complete aspect of delivering in cases of something abnormal. So, those are the differences with the lactation specialist. The IBCLC is the only one trained and skilled in seeing the whole picture and specializes in infant and maternal assessment and breastfeeding management. Anyone else besides an IBCLC make wonderful educators and advocacy in breastfeeding.

Nov 14

When Birth Trauma Causes Nipple Trauma

The number one complaint in nursing mothers is that they have sore nipples. There is another component to sore nipples – silent emotional pain. Think about it for a moment, every 2-3 hours around the clock the baby has to be fed. Mom dreads when the infant wakes or starts shoving fists in mouth because she knows she will have to endure shooting, stabbing, burning and toe curling pain for the duration of the feed. Day and night, week after week, moms endure this pain without seeking help. Why they do not seek out help? Usually the moms are made to feel that they are doing something wrong. Why would a mom want to pay for help just to have them tell her that she is doing something wrong? Breastfeeding is suppose to come natural right? Her peers and family have all told her that it is normal. The nurses and some lactation consultants in the hospital have all told her that the latch looks good, so therefore, it must be. Yet, she continues on with the severe pain thinking every 2-3 hours she is failing miserably as a mother. I have also seen women shut down emotionally to their babies because of this pain. They can’t enjoy their baby because of the physical pain being caused by the baby’s needs to feed. I have also seen mom relive some of the birth trauma she experienced every time the baby goes back to the sore and traumatized nipples.

There is this correlation that I thinks contributes to sore nipples: Dis-empowerment during the labor for whatever the reason(induction, epidural, forceps, cesarean, posterior labor, little support – mom shuts down emotionally intentionally or unintentionally. This can lead to more medical interventions in the labor – which leads to more emotional trauma for mom and physical trauma for baby. In order to cope, the mom will stop listening to her own maternal instincts. She will no longer trust her body completely because others are making the decisions for her. How this plays out is that when the baby is finally in her arms, she has already been dis-empowered by the birth and therefore feel that she isn’t equipped with making decisions or voicing her needs effectively.

The good news is as an IBCLC, healing those sore nipples ASAP is top priority. When mom sees that someone is listening and she is seeing the possibilities of pain-free breastfeeding, the emotional trauma starts to clear up. Her confidence returns and the mother and baby relationship can thrive.

Nov 08

Mother-to-Mother On-Line Support Can Cause More Harm than Good

There are so many groups on social media that are supportive of mothers who are expecting a child or breastfeeding. Women can post their issue or problem in hopes to get FREE advice. The benefit to this outlet is that a mom can get instant advice, support and validation. But what if that support disguised as simple and “helpful” is not anywhere accurate or evidence based?

For example a mother writes on a facebook group or any mother forum and states:

“I have sore nipples and my baby cries all day. I went to my pediatrician for the 2 week check up and my baby isn’t gaining weight. My pediatrician wants me to supplement but I don’t want to.”

Immediately as women we want to embrace this mom and let her know that she is not alone. We want to validate and help her in anyway. What would you say to her? Have you had this experience yourself?

Some of the common responses are:

You don’t need to supplement. My baby didn’t gain weight until 4 weeks and my baby turned out fine.

Just keep your baby at the breast. Their tummies are small and don’t need much to eat.

Take a bath with your baby. Lots of skin to skin.

“Get a new pediatrician! It is really important to have a pediatrician support your wishes. You are the mom, you don’t have to listen to anyone.”

“Make sure you get a good nipple cream for your sore nipples as I really thought olive oil helped with healing my nipples.”

“It is normal for your baby not to gain weight at first.”

“Your nipples will toughen up. Hang in there.”

“Use a nipple shield, that helped my sore nipples heal. I couldn’t have breastfed without it.”

When we are sick with a 104 temperature and coughing up blood, we sure are not going to tell anyone not to listen to their doctor and to just go back to bed and drink lots of water. We are going to suggest that they go to the doctor to rule out the flu, bronchitis, sinus infection, or something more serious. That way, the person can know what is really going on and get the proper treatment for wellness.

As a professional I look into this question with ALOT of red flags. Is this baby tongue tied? Did this mom have a really hard labor and alot of IV fluids and her milk is slow coming in? Does she have postpartum depression and has disconnected to her baby and therefore not paying attention to proper latch and position therefore, causing sore nipples and baby not gaining enough weight? Is this mom in that 1% where they just don’t make enough milk? Does this baby have a sucking issue caused by a tongue tie or birth trauma? If any of those questions I pose are true then none of the suggestions this mom is receiving is going to help and actually, reduce her confidence in breastfeeding even more.

What I would say instead;

“I know you would prefer not to supplement, but let’s find the real reason why your baby may not be gaining weight and the cause of your sore nipples. There might be a way to avoid supplementation, your baby gain the necessary weight and have your doctor be happy. Let me ask you some more questions about what is going on and we can figure it out together.”

As a mom offering advice on a mom fortum or facebook group when not an IBCLC can ask more questions to let the mom know that you are validating her. For example,

“Having sore nipples is not normal. There might be another underlining cause. Can you pay a visit to a lactation consultant or a Le Leche League Leader?”

“You sound frustrated and rightly so. We want to be good moms and then a doctor comes along and tells us we might be doing something wrong. I would look into finding someone who deals with lactation so they can assess the situation.”

“Hang in there Mom, you can do this and congratulations on choosing to breastfeed. The best success is finding a professional to help you.”